Can’t Locate Metastasis!

[JolleySprings]

My husband’s PSA is 17+

(His journey is in bio)

2 PSMA scans since Oct yet PSA continues to climb.

3 weeks ago Had CT scan with Contrast. Enlarged lymph appeared in para aortic Abdomen area.

We have met with 3 Radiation Oncologist. All 3 have differing opinions.

Dr. Julian Hong at UCSF and his team do not think it is the issue.

Recommended another scan.

one other RO thinks PROTON beam to area is in order.

So difficult to know what to do, but will for sure be doing another type scan.

Any thoughts on this? My “laymen” thought is … if it is of significant size… wouldn’t the CT with contrast have picked it up?

After Lupron & NUBEQA failed. Now on Zytiga. But PSA is still rising.

Thanks for thoughts … and any similar situations!

[God_Loves_Me]

I think I read somewhere in this group, to do FDG Scan if PSMA Scan failed to locate the area

[Tall_Allen]

FDG PET/CT might find it.

[JolleySprings in reply to Tall_Allen]

RO ordered Auxium Scan today. He told us my hubby, Steve, has a very unusual case! 😩🙏🏻🙏🏻🙏🏻

[V10fanatic in reply to JolleySprings]

Listen to Tall Allen. I had 2 negative PSMA scans, but an FDG picked up 4 distant mets. I hit them with SBRT and cleaned them up.

[EdBar]

Not all cancers put out PSMA that will be picked up by the PSMA scan. Perhaps a different scan will help. This was mentioned during a PCF webinar last night hosted by Oliver Sartor and included Michael Morris, two of the pioneer/experts when it comes to PSMA and PSMA related therapies.

Ed

[FaithOverFear104 in reply to EdBar]

Do you happen to know if there is a replay of the webinar w Drs Morris and Sartor available? I had planned for us to be on it but we missed it unfortunately. My husband is in a similar boat to the OP's husband.

[EdBar in reply to FaithOverFear104]

They usually have a replay available after a few days, I know it was being recorded. Perhaps if you check the website or even YouTube you might be able to find it.

[FaithOverFear104 in reply to EdBar]

Thank you so much. I will search for it.

[FaithOverFear104 in reply to EdBar]

Based on previous PCF webinars, it should be posted to their website at some point hopefully before too long. I will keep an eye out for it. thanks again.

[SnakeDoctor]

I have stage 4 with 2 spots in pelvic . Been on Lupron ansd Xtandi for 2 1/2 years and PSA is .06

So don’t have any good info on your situation

Good luck

[PELHA in reply to SnakeDoctor]

No chemo? Husband on quarterly Lupron since January and started Erleada a month ago. PSA coming down nicely (9.6 to 1.8). He has a handful of bone Mets but they have not recommended chemo yet. Next month a scan to see how Mets responding. I keep seeing triplet is SOC but maybe some don’t do all three?

[FaithOverFear104]

I am praying all the best for your husband and for you. My husband is in a somewhat similar situation to yours, in that his PSA is slowly climbing (It is now just under 10), and two PSMA PETs showed no mets. I asked his MO at Sloan Kettering if we should be doing other types of scans and his doctor did not suggest FDG PET, as others have mentioned, or anything else. We missed the PCF foundation webinar from the other night that Ed mentioned in his reply to you - but if I can get a hold of it, I'd like to see what Dr. Morris, who is a colleague of my husband's MO, had to say. If it differs from what we are being told, I cannot understand why there would not be collaboration and consensus amongst doctors within the same department at a major institution.